How much is 716 billion, and what would it really do to patient care?

By Abraham Schwab
for the News-Sentinel

Wednesday, October 10, 2012 - 10:58 am

In the debate Oct. 3, Mitt Romney and President Obama discussed the number “716 billion” quite a bit.

Personally, I have trouble understanding billions. So I tried to figure out what 716 billion means in terms of seconds. I've lived in Fort Wayne for a couple of years, so maybe there's some relationship between the time I've been in Fort Wayne and 716 billion seconds. It turns out that didn't work: 716 billion seconds is almost 23,000 years.

Then, I thought maybe I could understand 716 billion in terms of calories. Like the ones we watch (or not) in the food we eat and the beverages we drink. I've been around for more than three decades, so maybe looking at the calories I've eaten in my life would give billion some context. Turns out that idea didn't work out either, but you know what you could do with 716 billion calories' worth of food and drink? Feed the combined population of Allen, Wells and Whitley counties for about two years.

Mitt Romney and President Obama were discussing 716 billion in the context of Obamacare and the Medicare budget. This got me thinking: Why not look at 716 billion in the context of the Medicare budget?

As we know, the 716 billion (that Romney called “cuts” and Obama did not) is coming out of Medicare's budget over the next 10 years. How much of Medicare's budget will that be? It's tough to tell, but if Medicare's budget increases at the same rate that it has for the last 10 years, 716 billion would be around 5 percent of the total budget for the next 10 years. If, however, Medicare's budget remains constant at the 2013 projected level, the 716 billion would be around 8 percent of the total. So we're talking about cutting somewhere between 5-8 percent of Medicare over the next 10 years. That seems like a lot. But maybe it's not. Medicare might be like the 250-pound guy who is 50 pounds overweight. If that guy cuts the fat and loses 5-8 percent of his weight, he's still at least 30 pounds overweight. But Medicare might also be like the 160-pound guy whose body fat only makes up 8 percent of his weight. If he loses 5-8 percent of his weight, well, he's not only cutting fat, but other stuff as well. So, the question we've got to answer is: Is Medicare more like the overweight guy or the in-shape guy?

I don't know the answer to this question. I study medical ethics for a living, and I could tell you all about how these cuts make a lot of sense for a number of reasons. We, as the citizens of the United States, refuse to say no to ourselves. We spend huge sums of money on patients at the end of life, leaving less money to spend on other patients.

I can also talk about how the way that money moves through the health care system hides from patients the true cost of their care. This means that they'll accept any care that is offered, so if you want to control costs, you have to offer less care.

But these arguments won't tell us what this 716 billion will actually do to patient care. As President Obama noted, the way the 716 billion shakes out is through lower payouts to providers and prescription drugs. Will these lower payouts affect the care provided for Medicare patients? What are health care providers planning to do about these coming changes?

Romney also criticized Obamacare for its effect on business. He argued that businesses wouldn't start up, that businesses might close down and that businesses wouldn't thrive because of Obamacare.

Personally, I've worked for a lot of businesses, but I've never owned one, so even though I can tell you all about the carrots (tax breaks for some small businesses who provide coverage) and sticks (penalties for those who have more the 50 employees who don't provide insurance for their employees) that you'll find in Obamacare, I can't tell you how a small-business owner has or will respond to Obamacare.

Now, I've had people tell me that they work for businesses that are not going to hire full-time employees because of Obamacare. But everything I've heard is second- or third-hand, and I'd like to know how a small business is actually responding to what has been and what will be implemented as part of Obamacare.

And I'd also like to know from physicians, businesses, hospitals and health insurers what they'd do differently if Obamacare is repealed?

It's for all these reasons that I've asked four people to come together and talk about what they've done, what they're doing and what they expect to do as Obamacare continues to be implemented (or not). These generous people are Kathy Carrier, CEO of Briljent and Keepsake Threads; Rick Cochran, CEO of Physicians Health Plan of Northern Indiana, Inc.; Ray Dusman, executive physician administrator at Parkview Health; and Jonathan Walker, retinal surgeon and assistant clinical professor at IU School of Medicine, Fort Wayne. At noon Oct. 22, they'll be in Neff 101 on IPFW's campus to talk about their experiences and answer questions (yours and mine) about Obamacare, what it means for them and what it could mean for you.

Abraham Schwab is assistant professor in the philosophy department at IPFW.